| NPI | 1336597582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63214) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 94-08957) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-03-31 |