| NPI | 1821582305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 66131) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL52789) |
| 208600000X Surgery (Licence: SC LL52789) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2020-08-24 |