| NPI | 1609284660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A138112) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01083380A) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-03-07 |