NPI | 1043672892 |
---|---|
Former Name | YONG SOO PARK |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3676) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1170) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-03-22 |
Last Update Date | 2022-03-28 |