| NPI | 1356612097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: MN 469546) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: CA RHF 00098351) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |