| NPI | 1154825172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A164159) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10062892) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2019-10-14 |