| NPI | 1346655982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 75066) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-01683) |
| 208600000X Surgery (Licence: GA 6803) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-08-28 |