| NPI | 1922665744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 94899) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL82602) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-07-22 |