| NPI | 1205566957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2023014966) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2022021269) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2023-07-06 |