| NPI | 1578995346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: FL RA50) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL CRT62993) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |