| NPI | 1073558177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 31633) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2007001559) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2022-08-02 |