| NPI | 1689758708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD14263) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 14263) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-11-13 |