| NPI | 1912138926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2015021375) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101018202) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02004420A) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2020-02-28 |