| NPI | 1255324968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 40400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27504) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301070458) | |
| Enumeration Date | 2005-08-27 |
| Last Update Date | 2009-07-13 |