| NPI | 1306031232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA 00156971) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: WA 00006824) |
| 247100000X Radiologic Technologist (Licence: MN 284362) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |