| NPI | 1417638628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R4582) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 9914) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2025-08-08 |