| NPI | 1003101130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R3434) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.140201) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IL 036.140201) | |
| 207R00000X Internal Medicine (Licence: IL 125.059992) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2019-12-03 |