| NPI | 1134106909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 26108) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25034) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-22019) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2015-04-03 |