| NPI | 1376049940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD61513046) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60856563) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-10-04 |