| NPI | 1306259858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A197161) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 7663) |
| 208600000X Surgery (Licence: SC LL36969) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2025-03-28 |