| NPI | 1962815027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD469646) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.148117) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT206283) | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2020-09-30 |