| NPI | 1598499097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 75092) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 32611) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2023-08-18 |