| NPI | 1346499936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: LA 10800) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: LA LA 2731) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2016-03-07 |