| NPI | 1386083053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125064325) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204896) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301501826) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2021-07-08 |