| NPI | 1891774410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61138785) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01059675A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01059675A) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2021-07-21 |