| NPI | 1104111442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 55692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 091861879) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA 141763) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-07-21 |