| NPI | 1063858793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 52010) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 65430) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2018009369) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-05-23 |