| NPI | 1538738158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2021021608) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL DO.4854) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2026-09-29 |