| NPI | 1225212491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 51786) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301088299) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2016-12-16 |