| NPI | 1851572366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120048) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66410) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54638) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2021-01-06 |