| NPI | 1760005813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS026251) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT020218) |
| Enumeration Date | 2020-05-24 |
| Last Update Date | 2026-07-02 |