| NPI | 1275944209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 86338) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206240) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2021-06-23 |