| NPI | 1568652691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-33237) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2009006303) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2014-08-01 |