| NPI | 1134111503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 24507) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 24507) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-08-07 |