| NPI | 1053305946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000035735) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 35735) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2009-10-07 |