| NPI | 1588192629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 51127) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 51127) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R9472) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2023-07-05 |