| NPI | 1255584025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: TN RA0000000002) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: TN MDX0000005085) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: KY 1012106598) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2012-01-30 |