| NPI | 1316989452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R6A68) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0420669) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-12-06 |