| NPI | 1457799470 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D90046) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125063614) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A155349) | |
| Enumeration Date | 2013-06-12 | 
| Last Update Date | 2021-08-13 |