| NPI | 1013977669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD40490) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME66660) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SD 5747) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MS 19195) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2013-03-26 |