| NPI | 1760646731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: IN xt016407) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: KY 10-121-12290) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2008-07-17 |