| NPI | 1902242654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 35610) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 35610) |
| 208600000X Surgery (Licence: IL 125062965) | |
| 208D00000X General Practice (Licence: CA A162079) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2023-11-21 |