| NPI | 1104809672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 1056) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A10431) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2019-03-14 |