| NPI | 1063489631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-24522) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 111830) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2014-08-01 |