| NPI | 1417941600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OR MD28019) |
| Additional Taxonomies | 2085R0001X (Licence: NM MD2016-0015) |
| 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: OR MD28019) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2025-07-31 |