| NPI | 1902337108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 125.071908) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-04-18 |