| NPI | 1588225528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: WA RT60107255) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: WA RT60107255) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2020-01-02 |