| NPI | 1851784748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN239598) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: MS ARRT436685) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |