| NPI | 1013066810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 41233) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 18714) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2017-02-03 |