| NPI | 1639160138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN DO0000001991) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 02002844A) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2012-08-30 |