| NPI | 1629053152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-22442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R2H86) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2015-08-18 |