| NPI | 1124288915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036139273) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NY 269667) |
| 2085N0700X Radiology Neuroradiology (Licence: NY 269667) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 55374) | |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2016-08-06 |