| NPI | 1548467376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 43458) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-07-21 |