| NPI | 1194254037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT213617) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME153874) |
| 208600000X Surgery (Licence: PA MT213617) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2025-01-09 |