| NPI | 1144771148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 247100000X Radiologic Technologist |
| 2471C3402X Radiologic Technologist, Radiography | |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |