| NPI | 1720617962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-50806) |
| Additional Taxonomies | 2085N0700X (Licence: MO 2021023178) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2021023178) | |
| 2085N0700X (Licence: KS 94-10694) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-06-18 |