| NPI | 1902801129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-25724) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 107934) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2013-08-01 |