| NPI | 1710360730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 34460) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 34460) |
| 208600000X Surgery (Licence: NE 7523) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-09-04 |