| NPI | 1700894805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME 93275) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 11874) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2009-02-12 |