| NPI | 1215317888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME149963) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 266705) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MO 2020015515) | |
| 208600000X Surgery (Licence: IL 125067171) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-03-28 |