| NPI | 1851796973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 7752) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OK 2037) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2022-09-04 |