| NPI | 1205029998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G9917) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX G9917) |
| 2086S0129X (Licence: TX G9917) | |
| 2086S0129X (Licence: ID 8961073) | |
| Enumeration Date | 2007-08-25 |
| Last Update Date | 2024-12-09 |