| NPI | 1215133038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3401X Radiologic Technologist Computed Tomography (Licence: GA 309371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 06WI1204) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2007-07-08 |