| NPI | 1063668002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3402X Radiologic Technologist, Radiography (Licence: FL BMO72850) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA53981) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2009-03-06 |