| NPI | 1891909669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101243519) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 42340) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-08-09 |