| NPI | 1063906550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 94-09645) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-51302) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-05-15 |