| NPI | 1306037759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0049592) |
| Additional Taxonomies | 2085N0904X (Licence: CO 49592) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 49592) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2026-05-13 |