| NPI | 1427497403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 390200000X) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT203401) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2018-05-14 |