| NPI | 1235511957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: OH 68.000011) |
| Additional Taxonomies | 2471V0106X Radiologic Technologist Vascular-Interventional Technology (Licence: OH R8859468) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2015-06-19 |