| NPI | 1508150012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: FL CRT67489) |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant (Licence: GA 11 GA 1428) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |