| NPI | 1659321438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-30803) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2004012743) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-06-27 |