| NPI | 1194788042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 00-38331) |
| Additional Taxonomies | 174400000X Specialist |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 38331) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 38331) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: NC 38331) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2024-11-05 |