| NPI | 1487795092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME135981) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN304) |
| 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: 76083) | |
| 2471S1302X Radiologic Technologist, Sonography (Licence: 76083) | |
| 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: 76083) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2019-10-24 |