| NPI | 1801039219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088321) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 42408) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 30278) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2018-12-03 |