| NPI | 1194792275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-19891) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R9A02) |
| 2085B0100X Radiology Body Imaging (Licence: MO R9A02) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2012-09-14 |