| NPI | 1497169262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57.027016) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125065495) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-03-28 |