| NPI | 1659376952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-17213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS KS 04-17213) |
| 207Q00000X Family Medicine (Licence: MO MO R5059) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R5059) | |
| 208D00000X General Practice (Licence: KS 04-17213) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-04-19 |