| NPI | 1083698385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0044660) |
| Additional Taxonomies | 2085N0700X (Licence: CO 44660) |
| 2085N0700X (Licence: NC 200400806) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0044660) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2025-08-27 |