| NPI | 1235362252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MO 2016010164) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MO 2016010164) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2022-06-20 |