| NPI | 1205804267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IL 36092986) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2001004974) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-29913) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2010-01-28 |