| NPI | 1578911061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036.170625) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.072323) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2025-01-09 |