| NPI | 1578850053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D81529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9407696) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.206142) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-09-16 |