| NPI | 1639442353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: VA 13841) |
| Additional Taxonomies | 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: MD 135254) |
| 247200000X Technician, Other (Licence: KS 1344-5635) | |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2019-02-02 |