| NPI | 1164869293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 55131) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP02792) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2022-08-29 |