| NPI | 1114906898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 31270) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 35901) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2008-08-04 |