| NPI | 1780211193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 51659) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 285420) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-10-10 |