| NPI | 1811230311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0060007) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM A-2025-17) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 5377) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-11-24 |