| NPI | 1912535568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A23597) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.164137) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-08-07 |