| NPI | 1952982977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5151015205) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 5151015205) |
| 208600000X Surgery (Licence: MI 5151015205) | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-06-17 |