| NPI | 1467013219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 72821) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN29588) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-05-27 |