| NPI | 1902002744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011018257) |
| Additional Taxonomies | 2085N0700X (Licence: TN 49018) |
| 2085N0700X (Licence: MO 2011018257) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2025-07-25 |