| NPI | 1043244684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD06278) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 6278) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-11-09 |