| NPI | 1699907683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: CA rhb86717) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: MN 413109) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2009-08-10 |