| NPI | 1487861233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: MN 338284) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: MN 338284) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |