| NPI | 1912427113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281918) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 272811) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-12-21 |