| NPI | 1366599169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-01312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 42145) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42145) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-09-13 |