| NPI | 1639116221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 41827) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25146) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-36305) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-04-07 |