| NPI | 1922210624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-35611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 6546) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011011568) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2012-06-26 |