| NPI | 1336186022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 28343) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25141) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-36708) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-04-07 |