| NPI | 1952783672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 50686) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP981) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-06-10 |