| NPI | 1376922187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.005411) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IL 036131514) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036131514) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-02-19 |