| NPI | 1972599009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 10858) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: WV 10858) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2007-10-16 |