| NPI | 1922162015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65796) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 42995) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G87837) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2022-10-05 |