| NPI | 1386036960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography (Licence: 79559) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: 303382) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-02-19 |