| NPI | 1104288497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036137696) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8455) |
| 282N00000X General Acute Care Hospital (Licence: IL 036.137696) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2024-04-19 |