| NPI | 1053621219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography |
| Additional Taxonomies | 247100000X Radiologic Technologist |
| 2471V0105X Radiologic Technologist, Vascular Sonography | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2010-10-20 |