| NPI | 1649220120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 11838) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 0108146) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-01-19 |