| NPI | 1487230926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 125.077403) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125077403) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-06-30 |