| NPI | 1396966040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 6326) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60225585) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 6347) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-10-07 |