| NPI | 1932660578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-04063) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125073823) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 78160) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-03-02 |