| NPI | 1700136678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: FL TRP-95) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: FL trp-95) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2012-09-18 |