| NPI | 1477790913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C41560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.124462) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 144004-1) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD436949) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2009-10-13 |