| NPI | 1720105547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD 13280) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD 13280) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2015-02-16 |