| NPI | 1720014095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-28690) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21991) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2015-08-04 |