| NPI | 1891798682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H6320) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H6320) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-06-17 |