| NPI | 1568025468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U7068) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10066636) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-08-16 |