| NPI | 1811919830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD020682E) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: PA MD020682E) |
| 208D00000X General Practice (Licence: PA MD-020682-E) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-04-30 |