| NPI | 1922185875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60441577) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54598) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP637) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2021-01-06 |