| NPI | 1700829603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 22117) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: KY 22117) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-12-19 |