| NPI | 1568729598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 48338) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 300727) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-05-06 |