| NPI | 1386030021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MMD.39757 LL) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10052438) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2016-07-18 |