| NPI | 1750313094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 105955) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 35577) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036105557) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-08-14 |