| NPI | 1144516485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 66282) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 50268) |
| 208600000X Surgery (Licence: SC LL33899) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2023-07-11 |