| NPI | 1295091148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 50836) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 49643) |
| 2085B0100X Radiology, Body Imaging (Licence: TN 49643) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2021-07-13 |