| NPI | 1780970210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.206864) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 67809) |
| 208600000X Surgery (Licence: MA 249308) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-09-01 |