| NPI | 1568844512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54082) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R3808) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-07-21 |