| NPI | 1467696880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 53710) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: TN 53710) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2016-01-04 |