| NPI | 1902881345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 14079) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 22187) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2007-07-09 |