| NPI | 1376858068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.043232) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 31668) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2010-08-18 |