| NPI | 1134487242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: FL RA 26) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL CRT 24366) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-04-26 |