| NPI | 1184019572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63638) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 64011) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-07-23 |