| NPI | 1093890998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: KY 45625) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 1757-850) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 45625) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2019-08-23 |