| NPI | 1396000964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: AZ 11944) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: CA 384339) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |