| NPI | 1053388264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R6101) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-14242) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-08 |