| NPI | 1821215005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 26405) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 36516) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-07-09 |