| NPI | 1366482028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 34527) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22332) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13430-320) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79434) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-08-29 |