| NPI | 1528000296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 15166) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD15166) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-03-07 |