| NPI | 1821154121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MT189294) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 7832708-1205) |
| 2086S0129X Surgery Vascular Surgery (Licence: UT 7832708-1205) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2023-06-03 |