| NPI | 1376634048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD29053) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 29053) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-05-11 |