| NPI | 1669699278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 60048) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 05-35530) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 636) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2018-07-24 |