| NPI | 1528498037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography (Licence: AZ 129242) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: AZ 405273) |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2014-08-19 |