| NPI | 1609876689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD032907E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C10006396) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-08-05 |