| NPI | 1508804782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63689) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 17529) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-09-21 |