| NPI | 1952403453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000036796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD36796) |
| 207U00000X Nuclear Medicine (Licence: TN MD36796) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2012-10-18 |