| NPI | 1679005243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: IL 125.071442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.071442) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301115711) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2019-10-23 |