| NPI | 1710148937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A125575) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008016543) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2017-12-29 |