| NPI | 1669823985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OR MD206700) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-10677) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-09-07 |