| NPI | 1376038299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0071999) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.246161) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2024-07-01 |