| NPI | 1285261511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.075587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075587) |
| 208D00000X General Practice (Licence: IL 125.075587) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2021-05-18 |