| NPI | 1306106729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 29866) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10043387) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2018-05-14 |