| NPI | 1427611748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 316072-01) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351046727) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2024-07-03 |