| NPI | 1700272176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145117) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 67813) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55420) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP022) | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2021-07-29 |