| NPI | 1588846588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 49727) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2012009712) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2013-09-23 |