| NPI | 1699045211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R5600) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: AZ R73123) |
| 2086S0129X Surgery Vascular Surgery (Licence: TX R5600) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2024-03-06 |