| NPI | 1659376739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-23130) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 101868) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2026-05-04 |