| NPI | 1134321235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 47061) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 21805) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2025-08-17 |