| NPI | 1679614861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD013506) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E3994) |
| 208D00000X General Practice (Licence: TN md013506) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2015-05-18 |