| NPI | 1275825481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471V0105X Radiologic Technologist Vascular Sonography (Licence: NY 139269) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2017-07-13 |