| NPI | 1568801462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02006163A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 277993) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-02-08 |