| NPI | 1336490788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: KS 22-03979) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: KS 22-03979) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |