| NPI | 1518450030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471C1101X Radiologic Technologist, Cardiovascular-Interventional Technology |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 2471S1302X Radiologic Technologist, Sonography | |
| 261QR0208X Clinic/Center, Radiology, Mobile | |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2021-02-27 |