| NPI | 1336181361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 39802) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2002002718) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD17956) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2009-08-12 |