| NPI | 1447487095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101258515) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.056388) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101258515) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2015-08-11 |