| NPI | 1184870545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 55655) |
| Additional Taxonomies | 2085N0700X (Licence: IL 036.123956) |
| Enumeration Date | 2008-08-16 |
| Last Update Date | 2012-07-31 |