| NPI | 1528316601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MD D0079977) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD P28028) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2022-07-21 |