| NPI | 1972650851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 42351) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 43579) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-03-04 |