| NPI | 1699156422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: KS 05-43439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 05-43439) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 05-43439) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-11-21 |