| NPI | 1225293376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44342) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R1490) |
| 2085B0100X Radiology, Body Imaging (Licence: KY 44342) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2012-12-19 |