| NPI | 1962498154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42481) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2004003512) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01066074A) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2021-11-24 |