| NPI | 1396108999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A153707) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10055720) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-02-13 |