| NPI | 1780899351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: KY 05148) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101014732) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02004579A) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-01-06 |