| NPI | 1427405349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MD456286) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT210567) |
| 208600000X Surgery (Licence: PA MT210567) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2023-11-17 |