| NPI | 1417445768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-168557) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 73978) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2026-02-27 |