| NPI | 1376072256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020037119) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09159) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 9409159) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2024-02-22 |