| NPI | 1184175432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3402X Radiologic Technologist, Radiography (Licence: MN 271815) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: AZ 14256) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |