| NPI | 1053312694 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-111268) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 34288) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63867-20) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2017-10-06 |