| NPI | 1336670363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 56735) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY IP1567) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R5450) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-05-24 |