| NPI | 1598718942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 28548) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: KY 28548) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: KY 28548) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-12-19 |