| NPI | 1770726218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: FL CRT63921) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: FL CRT63921) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2021-06-21 |