| NPI | 1679604409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: AR RT 1281) |
| Additional Taxonomies | 2471M1202X Radiologic Technologist Magnetic Resonance Imaging (Licence: 256373) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |