| NPI | 1639691025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2567) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 272797) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-08-23 |