| NPI | 1992971816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 50348) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A95112) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2012-12-12 |