| NPI | 1285773275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 56352) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 2004-0425) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2018-06-01 |