| NPI | 1992090450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A148587) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125059812) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2017-06-19 |