| NPI | 1760600126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42537) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 42537) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-12-03 |