| NPI | 1255597654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2023-12-08 |