| NPI | 1790167872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.156307) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R3804) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-08-19 |