| NPI | 1669033874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 94-11793) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 31941) |
| 208600000X Surgery (Licence: NE 8479) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-07-02 |