| NPI | 1447561683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R4055) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10036859) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-09-07 |