| NPI | 1871021816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 72879) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 94-09176) |
| 207R00000X Internal Medicine (Licence: KS 94-09176) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2023-07-31 |