| NPI | 1801152517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.145371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061502) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA R-9873) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-44376) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2025-08-15 |