| NPI | 1205875788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-28207) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S6910) |
| 174400000X Specialist (Licence: KS 0428207) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2024-04-19 |