| NPI | 1831644251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: AZ 00096509) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: AZ CRT-11630) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2016-08-16 |