| NPI | 1770717787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 53075) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P7709) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2018-10-26 |