| NPI | 1053756361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 9408058) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: IA DO-05177) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2020-05-21 |