| NPI | 1700815594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 31476) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 16663) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2011-02-24 |