| NPI | 1265881957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1019407) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT211664) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2024-05-02 |