| NPI | 1083830749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 48427) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20729) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2015-01-28 |