| NPI | 1871642017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD436875) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: PA MD436875) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2015-04-22 |