| NPI | 1801921507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 43247) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2011009241) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-07-01 |