| NPI | 1871779371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036114812) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NJ 25MA08692200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08692200) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2020-08-07 |