| NPI | 1649566480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.150084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 75363) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011016825) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2020-10-25 |