| NPI | 1437154028 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IN 01042295A)  | 
| Additional Taxonomies | 2085N0700X  (Licence: ID M-17162)  | 
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101046026)  | |
| Enumeration Date | 2005-06-20 | 
| Last Update Date | 2023-06-05 |