| NPI | 1114419264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography (Licence: 129103) |
| Additional Taxonomies | 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: 129103) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |