| NPI | 1215966478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 35827) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: KY 35827) |
| 2085N0904X (Licence: KY 35827) | |
| 2085B0100X Radiology, Body Imaging (Licence: KY 35827) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2025-07-24 |