| NPI | 1598183832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A140345) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66115) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP601) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54586) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2021-01-06 |