| NPI | 1760481816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01062616A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 20805) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-07-09 |