| NPI | 1306008610 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2085N0700X (Licence: IN 01085242A) | 
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IN 11014539A) | 
| Enumeration Date | 2008-06-27 | 
| Last Update Date | 2021-02-18 |