| NPI | 1861619934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: KY 45364) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088536) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 45364) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-11-26 |