| NPI | 1861922031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA MD-49712) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125.070835) |
| 208600000X Surgery (Licence: IL 125.070835) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-06-27 |