| NPI | 1043884562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471C3402X Radiologic Technologist Radiography (Licence: OR 914117) |
| Additional Taxonomies | 2471C3401X Radiologic Technologist Computed Tomography (Licence: OR 914117) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-05-19 |