| NPI | 1790942274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 51548) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2020-08-31 |