| NPI | 1609489111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3401X Radiologic Technologist Computed Tomography (Licence: MN 572453) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: MN 572453) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2020-08-25 |