| NPI | 1659320646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 34424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 60021) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-12-03 |