| NPI | 1225443096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S6484) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT207215) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-03-01 |