| NPI | 1124769385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.080767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 123.080767) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2023-05-31 |