| NPI | 1992124762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX S1840) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036146640) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-12-05 |