| NPI | 1700917200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2008-00379) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R0779) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2008-07-24 |