| NPI | 1720432560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME134106) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R75470) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2018-03-17 |