| NPI | 1689167967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U3770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09491) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-07-15 |