| NPI | 1780895284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 45888) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2012-01486) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 35473) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2018-11-14 |