| NPI | 1114058781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 42926) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R0569) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42926) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01066513A) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-02-28 |