| NPI | 1124433974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 313456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08443) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2019-09-17 |