| NPI | 1316945728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 42838) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101267265) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.017184) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 25742) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2020-07-21 |