| NPI | 1275805731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: PA DC010753) |
| Additional Taxonomies | 2471S1302X Radiologic Technologist, Sonography (Licence: PA 23300) |
| 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: PA 23300) | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2018-11-15 |