| NPI | 1629418033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63701) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 23525) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2021-07-12 |