| NPI | 1164764395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 18767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125064319) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 55999) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2019-10-07 |