| NPI | 1992541536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0076814) |
| Additional Taxonomies | 2085N0700X (Licence: CO TL.0010463) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2026-06-01 |