| NPI | 1790012359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: NM RRT 2518) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: CA RHF 83103) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2009-11-03 |