| NPI | 1528702628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ R79310) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R79310) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-05-30 |