| NPI | 1508561218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY R6934) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R80824) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2025-07-31 |