| NPI | 1740817261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125077323) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC LL84285) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2021-06-30 |