| NPI | 1073721544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 20252) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN DO1865) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2023-03-07 |