| NPI | 1366674426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 65540) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60096298) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA 60096298) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2024-03-13 |