| NPI | 1679564751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000041630) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-12681) |
| Enumeration Date | 2005-10-29 |
| Last Update Date | 2009-01-20 |