| NPI | 1104948561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471B0102X Radiologic Technologist Bone Densitometry (Licence: FL CRT44197) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: FL CRT44197) |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2007-07-08 |