| NPI | 1659864684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: CO 497033) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 497033) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |