| NPI | 1174575773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2010009161) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.123770) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 49759) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-02-18 |