| NPI | 1841641164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2021014025) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016017305) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-05-19 |