| NPI | 1801279112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX S4562) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 65439) |
| 208600000X Surgery (Licence: OH 57.025757) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2025-03-20 |