| NPI | 1710981451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-17720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R7155) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2010-07-09 |