| NPI | 1639564115 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.157267)  | 
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IL 036.157267)  | 
| 2085N0904X  (Licence: IL 036.157267)  | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 67902-20)  | |
| Enumeration Date | 2015-04-01 | 
| Last Update Date | 2024-09-13 |