| NPI | 1821317009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125-054757) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 61637) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2024-06-12 |