| NPI | 1821067422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R6578) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-28026) |
| 2085B0100X Radiology Body Imaging (Licence: MO R6578) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2008-03-13 |