| NPI | 1144758467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 26372) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL41011) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-06-22 |