| NPI | 1215248695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: WA RT00004050) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: WA RT00004050) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2010-06-30 |