| NPI | 1962105031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: IL 125082098) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.082098) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2024-06-27 |