| NPI | 1972965267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 77071) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.068287) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 125068287) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-03-31 |