| NPI | 1790765105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD037913E) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: PA MD037913E) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: PA MD037913E) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2015-06-01 |