| NPI | 1437153889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 32348) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: KY 32348) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 32348) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2016-10-07 |