| NPI | 1225567902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301508654) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD17244) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 290918) | |
| 208600000X Surgery (Licence: RI LP04037) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-12-18 |