| NPI | 1659722361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME158352) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY IP1518) |
| 208600000X Surgery (Licence: SC LL39706) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-02-13 |