| NPI | 1083007793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: NY R000185-1) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: NY 473120) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2015-03-05 |