| NPI | 1700864972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 25675) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 019834) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-01-09 |