| NPI | 1164124228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology |
| Additional Taxonomies | 247100000X Radiologic Technologist |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-03-21 |