| NPI | 1326254913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 24494) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 24494) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2021-06-15 |