| NPI | 1639578008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471S1302X Radiologic Technologist, Sonography (Licence: AZ 96957) |
| Additional Taxonomies | 2471N0900X Radiologic Technologist, Nuclear Medicine Technology (Licence: AZ 272082) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |