| NPI | 1851564892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-37136) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2012-00234) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2015-03-11 |