| NPI | 1861826950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: MN 454001) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: MN 454001) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-08-26 |