| NPI | 1689295388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471V0106X Radiologic Technologist Vascular-Interventional Technology |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2020-05-04 |