| NPI | 1699956425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: 105039) |
| Additional Taxonomies | 2471S1302X Radiologic Technologist, Sonography (Licence: 105039) |
| 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: 105039) | |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2007-11-20 |