| NPI | 1700052149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A113538) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IL 036117120) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036-117120) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A113538) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA08887200) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA08887200) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2011-07-29 |