| NPI | 1215972856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-15993) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 18405) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R5851) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2010-07-02 |