| NPI | 1700413689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC MMD.85708) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN30783) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2021-07-16 |