| NPI | 1346217973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 97997) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD39942) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-04-03 |