| NPI | 1043232879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 42009) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: TN 42009) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2023-03047) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-01-16 |