| NPI | 1699906669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A121425) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.124012) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A121425) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2012-06-20 |