| NPI | 1649274184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-19040) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R4B58) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2007-07-08 |