| NPI | 1619396934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT208646) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036177628) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A169104) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2026-09-23 |