| NPI | 1083632095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL 35380) |
| Additional Taxonomies | 2471M1202X Radiologic Technologist Magnetic Resonance Imaging (Licence: 256881) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |