| NPI | 1588699136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 20680) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME137815) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-01-02 |