| NPI | 1114587623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-17197) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 74045) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2026-08-04 |