| NPI | 1174964829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 18763) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 18763) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-07-10 |