| NPI | 1538504659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D85529) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT204401) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2018-05-30 |