| NPI | 1497081319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: 07 TX 1287) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL 54399) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2009-10-28 |