| NPI | 1104815240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-113425) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 236740) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 236740) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-12-05 |