| NPI | 1326400490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-14770) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 338180) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R5171) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2023-08-01 |