| NPI | 1003088113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 47158) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21777) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2015-01-28 |