| NPI | 1235210634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R3061) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-11028) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2011-05-06 |