| NPI | 1356389597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 42095) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 5223918-1205) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2014-04-28 |