| NPI | 1487855284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL 29360) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: 240949) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-08 |