| NPI | 1750720900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277381) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 57169) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-12-19 |