| NPI | 1124361829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL CRT69731) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: FL CNA138224) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2013-04-01 |