| NPI | 1730171349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD44796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 36211-020) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 36211-020) | |
| 208600000X Surgery (Licence: WI 36211-020) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2018-03-19 |