| NPI | 1417983370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 42835) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD37485) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-10-21 |