| NPI | 1083135180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017022167) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017022167) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2019-08-12 |