| NPI | 1497310064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 73700) |
| Additional Taxonomies | 2085N0700X (Licence: TN 73700) |
| 2085N0700X (Licence: MS 35488) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 35488) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-11-04 |