| NPI | 1730062720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: MO 1081539) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: KS 22-07254) |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-07-28 |