| NPI | 1538428081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 201801308) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R2914) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2018-09-14 |