| NPI | 1003078015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N9814) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 4497) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036128015) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 53280) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2018-08-08 |