| NPI | 1205188398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: AZ 16607) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL CRT12622) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |