| NPI | 1609352491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 30414) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT217037) |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2019-07-05 |