| NPI | 1154764462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 54137) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 26548) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D85514) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2019-06-18 |