| NPI | 1003818873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 45471) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036087961) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2024-06-21 |