| NPI | 1245213420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R5572) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 28544) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2010-09-28 |