| NPI | 1619354735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 71600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T0376) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2024-06-17 |