| NPI | 1124253521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant |
| Additional Taxonomies | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2009-05-28 |