| NPI | 1366820649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4141) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 54830) |
| 208800000X Urology (Licence: AZ R74986) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2023-07-05 |