| NPI | 1912980194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 143388) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 23369) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2010-09-28 |