| NPI | 1265882674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36847) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016018548) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-06-04 |