| NPI | 1235512021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471V0105X Radiologic Technologist Vascular Sonography (Licence: PR 0007) |
| Additional Taxonomies | 2471S1302X Radiologic Technologist Sonography (Licence: PR 0007) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |