| NPI | 1417410804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A193554) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77335) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R77335) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-07-11 |