| NPI | 1477675452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 44947) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 054995) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2007-00477) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-05-08 |