| NPI | 1023469186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 21037) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69270) |
| 208600000X Surgery (Licence: NE 7711) | |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2023-12-08 |