| NPI | 1124246954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000048359) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21449) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR e6918) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2012-08-06 |