| NPI | 1659310316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 15620) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP388) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 49780) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2017-01-10 |