| NPI | 1831849439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA PTL8890) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-12709) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-05-15 |