| NPI | 1801931480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: TN 2067) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: TN 2067) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |