| NPI | 1558325282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-31921) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L3394) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006013165) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2013-08-01 |