| NPI | 1649460551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 11489) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01066294) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4031084280) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-04-06 |