| NPI | 1205878857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 1835) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 58575) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS9950) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2021-06-15 |