| NPI | 1164117966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 58.033899) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151016208) |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2024-07-05 |