| NPI | 1619321478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-01536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0068019) |
| 208600000X Surgery (Licence: NC 218001) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2022-08-19 |