| NPI | 1851389043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD040732E) |
| Additional Taxonomies | 2085N0904X (Licence: PA MD040732E) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2011-03-07 |