| NPI | 1205190147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IN 01073121A) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 5118-850) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62743) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 62743) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2019-08-07 |