| NPI | 1104115732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0063259) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 56103) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2021-05-10 |