| NPI | 1285672162 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography (Licence: FL HCC4323) | 
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: FL HCC4323) | 
| Enumeration Date | 2006-06-03 | 
| Last Update Date | 2025-09-11 |