| NPI | 1851703334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01076741A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2023-06-13 |