| NPI | 1770100224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2021023806) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2020019363) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2021-08-02 |