| NPI | 1114077401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: 347107) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: 347107) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2026-03-15 |