| NPI | 1154529444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 40413) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: IL 036.128071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 46133) | |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2020-01-24 |