| NPI | 1235511924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A173818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08734) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-09-09 |