| NPI | 1982016911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A140321) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 65806) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP678) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54608) | |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2021-01-06 |