| NPI | 1194386920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 8875) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT219316) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2020-08-10 |