| NPI | 1346702750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125.073706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073706) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2020-07-04 |