| NPI | 1245475649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 31177) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44326) |
| Enumeration Date | 2008-12-13 |
| Last Update Date | 2022-05-09 |