| NPI | 1720023369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-17362) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 19122) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2003004598) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2010-07-02 |