| NPI | 1861506222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT190021) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: PA MD436113) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2012-10-15 |