| NPI | 1285122341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY TP078) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX BP20066772) |
| 208600000X Surgery (Licence: TX BP10062891) | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2024-06-06 |