| NPI | 1063830784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65274) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS16633) |
| 2085N0700X (Licence: IL 036.148128) | |
| 2085N0700X (Licence: FL OS16633) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2026-08-17 |