| NPI | 1710914304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-22306) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 19106) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2002031479) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2010-07-02 |