| NPI | 1316345218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: WA XT60353146) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: WA PC60347734) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-11 |