| NPI | 1598151631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: TX 438562) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: TX 438562) |
| 247100000X Radiologic Technologist (Licence: TX 94665) | |
| 247100000X Radiologic Technologist (Licence: AZ 17702) | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2015-04-15 |