| NPI | 1629276555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-34419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9406795) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-08-27 |