| NPI | 1881386332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2024013682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-11350) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024013682) | |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2024-07-22 |