| NPI | 1508216920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2016017560) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016017560) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2019-09-12 |