| NPI | 1487636569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01079663A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 34489) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-01-27 |