| NPI | 1164818175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 68621) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 264638) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-06-22 |