| NPI | 1457880015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP10063529) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125070199) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2019-10-07 |