| NPI | 1750817284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 33613) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2023-06-20 |