| NPI | 1669735809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: IL 036.147129) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301101455) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2020-09-14 |