| NPI | 1023363082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-10061) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301100965) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2021-04-12 |