| NPI | 1659990919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP10070448) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD.MD.70105605) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-05-15 |