| NPI | 1073514758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-095047) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 33679) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 64078-20) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2017-10-06 |