| NPI | 1538507256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-42177) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301103192) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D84911) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2019-05-30 |