| NPI | 1639285505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471C3402X Radiologic Technologist Radiography (Licence: TX 20514) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: 331647) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |