| NPI | 1134895758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: IL 125.080580) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL TRN-34072) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125080580) | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2023-10-10 |