| NPI | 1871887141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: 11ID1432) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: 343232) |
| 2471C3401X Radiologic Technologist Computed Tomography (Licence: 343232) | |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2011-06-04 |