| NPI | 1861493603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036165392) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C4314) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2025033845) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2025-08-11 |