| NPI | 1154600104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: ND 19767) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036135666) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX S8728) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2024-01-23 |