| NPI | 1861951881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 102432) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN28103) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-01-04 |