| NPI | 1790744324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 38527) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0038527) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 329602) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2026-02-05 |