| NPI | 1306371752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 61279) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00764) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-05-10 |