| NPI | 1548669161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: UT 07GA1282) |
| Additional Taxonomies | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: GA 213758) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |