| NPI | 1447714712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.079185) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: PR 35628) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2022-06-21 |