| NPI | 1356068340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: FL RA150) |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant (Licence: FL 22FL1219) |
| 2471C1101X Radiologic Technologist, Cardiovascular-Interventional Technology (Licence: FL CRT78340) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2023-02-20 |