| NPI | 1053724005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0061610) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-41049) |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2020-02-26 |