| NPI | 1851529424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 47288) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY R2527) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-01-10 |