| NPI | 1902964679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 16410) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 16410) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-12-15 |