| NPI | 1861428393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-18163) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21973) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2002026124) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |