| NPI | 1316962319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: 302643) |
| Additional Taxonomies | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: 302643) |
| 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: 302643) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |