| NPI | 1932660578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 78160) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: IL 125073823) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-06-21 |