| NPI | 1710120217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: PR 2194) |
| Additional Taxonomies | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: PR #87) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2009-04-13 |