| NPI | 1912967852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 61262) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01097274A) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2026-01-09 |