| NPI | 1659634301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 78084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 28983) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL34791) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2024-07-30 |