| NPI | 1104820513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-14189) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R5455) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-03-15 |