| NPI | 1053307223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 17613) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD0000017613) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2023-06-21 |