| NPI | 1891762589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-14430) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R4952) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2009-02-20 |