| NPI | 1497441570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 94-12126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2024026179) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2025-06-07 |