| NPI | 1598751810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD15386) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 92212) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2024-08-21 |