| NPI | 1851702831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036150543) |
| Additional Taxonomies | 2085R0001X (Licence: TX T0405) |
| 2085R0001X (Licence: WA MD61123324) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: IA MD46185) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2024-05-08 |