| NPI | 1710980677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A105121) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A105121) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2019-06-04 |