| NPI | 1124417795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125068675) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL S36206288204) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2017-06-05 |