| NPI | 1831179142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 58183) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD417463) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY TP584) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2023-10-25 |