| NPI | 1992118723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37012) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CO 61929) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL37012) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15093) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2022-03-28 |