| NPI | 1720059991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-31236) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 110351) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-04-28 |