| NPI | 1962018382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: MO 2020013277) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-180321) |
| 2085N0904X (Licence: IL 036-180321) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2026-08-26 |