| NPI | 1740832641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0074102) |
| Additional Taxonomies | 2085N0904X (Licence: CO DR.0074102) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0074102) | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2025-07-01 |