| NPI | 1104016989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant |
| Additional Taxonomies | 247100000X Radiologic Technologist |
| 2471C3401X Radiologic Technologist, Computed Tomography | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2021-12-13 |