| NPI | 1538118468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: KY 40790) |
| Additional Taxonomies | 2085N0700X (Licence: GA 054477) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 054477) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 40790) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2010-03-08 |