| NPI | 1700099561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101016517) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02003830A) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-09-01 |