| NPI | 1609814623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 37502) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01096584A) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-05-06 |