| NPI | 1386133890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 12701628-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ R76739) |
| 208600000X Surgery (Licence: AZ R76739) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2022-02-15 |