| NPI | 1912469685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 250925) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 250925) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2020-06-10 |