| NPI | 1952391401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 76325) |
| Additional Taxonomies | 2085N0700X (Licence: AR E-4365) |
| 174400000X Specialist (Licence: AR E4365) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-4365) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2023-03-07 |