| NPI | 1629497870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: FL 130714) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.148590) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-09-07 |