| NPI | 1629076310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD017446E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD017446E) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PA MD017446E) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2008-05-29 |