| NPI | 1609053198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 50746) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 001485) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2016-10-13 |