| NPI | 1033608880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U8722) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10063105) |
| 208600000X Surgery (Licence: TX BP10063105) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2024-06-05 |