| NPI | 1225587827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL 75593) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy |
| Enumeration Date | 2016-09-25 |
| Last Update Date | 2016-10-07 |