| NPI | 1174164909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL CRT71452) |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant (Licence: FL 11FL1443) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2020-01-27 |