| NPI | 1659931335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A197109) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A197109) |
| 208600000X Surgery (Licence: SC LL82805) | |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2025-10-27 |