| NPI | 1063655660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44180) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301094401) |
| 2085B0100X Radiology, Body Imaging (Licence: KY 44180) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2014-07-31 |