| NPI | 1639626229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125076576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076576) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-06-29 |