| NPI | 1730343674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 44986) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY R1695) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2014-05-23 |