| NPI | 1972766806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 30438) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: WI 390200000X) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52200) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2014-06-17 |