| NPI | 1083810170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: FL 57646) |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2008-10-23 |