| NPI | 1699206961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83755-20) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA TBD) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 313889) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-08-29 |