| NPI | 1578644258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: GA 027241) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 027421) |
| 208600000X Surgery (Licence: GA 027421) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-03-11 |