| NPI | 1356397863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 17388) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 7126) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 03187R) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-03-07 |