| NPI | 1710951579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT191695) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101235097) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2007-07-27 |