| NPI | 1578541439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 15386) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 20169) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2021-08-04 |