| NPI | 1679609713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD439563) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C7-0002918) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D68791) | |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2011-11-28 |