| NPI | 1366858987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD17641) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105001) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2021-08-12 |