| NPI | 1780903278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD457909) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197890) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2021-03-10 |