| NPI | 1609877265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-107236) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63802-20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 35410) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2017-10-06 |