| NPI | 1831141092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 18237) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 29194) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101246838) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-09-12 |