| NPI | 1508063660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-36379) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 5625) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2013006633) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2013-08-01 |