| NPI | 1114077401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: 347107) |
| Additional Taxonomies | 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: 347107) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2025-09-11 |