| NPI | 1962451674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00037860) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD45628) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-07-21 |