| NPI | 1952307480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IN 01047083A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01047083A) |
| 208D00000X General Practice (Licence: OH 35.079654) | |
| 208D00000X General Practice (Licence: KY 48179) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2021-09-15 |