| NPI | 1962592964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 40968) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0051294) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 40968) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0051294) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2009-02-09 |