| NPI | 1164604591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 16777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 047351) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD446969) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2021-03-29 |