| NPI | 1265579551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036137932) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2167) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0051338) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-01-17 |