| NPI | 1578956769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: NV 461473) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: OR 914564) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |