| NPI | 1972634541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME109966) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R1277) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01068003) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-10-26 |