| NPI | 1760758148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: NY 000189) |
| Additional Taxonomies | 2471C1101X Radiologic Technologist, Cardiovascular-Interventional Technology (Licence: NJ 624943) |
| 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: NY 914462) | |
| 261QR0200X Clinic/Center, Radiology (Licence: NY 000189) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-07-24 |