| NPI | 1619152022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471B0102X Radiologic Technologist, Bone Densitometry (Licence: TX 321690) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: TX 321690) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |