| NPI | 1164748091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24376) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 48063) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 48063) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2017-02-10 |