| NPI | 1699782912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E3490) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 41011) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-03-10 |