| NPI | 1457671760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 50755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL32733) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000050755) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2024-08-14 |