| NPI | 1972793750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2008-00824) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01066330A) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO 53835) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2023-03-08 |