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 |