| NPI | 1104387414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072604) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CO DR.0072604) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0072604) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0072604) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-05-17 |