| NPI | 1417644089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX BP20090643) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10082951) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2024-05-22 |