| NPI | 1659997187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1028036) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 21-1103) |
| 208600000X Surgery (Licence: SC LL84517) | |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2026-06-13 |