| NPI | 1164869327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2017-01076) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-255284) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2023-09-25 |