| NPI | 1972765097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01073085A) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 263305) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2013-08-23 |