| NPI | 1912205675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NC 2021-00777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 6959-851) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-00777) | |
| 208600000X Surgery (Licence: AZ R75577) | |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2021-06-15 |