| NPI | 1477593002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP210) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Pending) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-12-02 |