| NPI | 1730756677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 72159) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL17426) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2022-07-29 |