| NPI | 1790711240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-15362) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R7026) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |