| NPI | 1699390419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 12841) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT221071) |
| 208600000X Surgery (Licence: GA 12841) | |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2023-04-26 |