| NPI | 1922091180 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000025113) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 1053363) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01053363A) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IN 01053363A) | |
| Enumeration Date | 2005-08-23 | 
| Last Update Date | 2013-03-28 |