| NPI | 1720455710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471M1202X Radiologic Technologist Magnetic Resonance Imaging (Licence: MN 411969) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist Radiography (Licence: MN 411969) |
| 2471C3401X Radiologic Technologist Computed Tomography (Licence: MN 411969) | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |