| NPI | 1982606620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62601) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02001737A) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2014-08-08 |