| NPI | 1891706214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: 364369) |
| Additional Taxonomies | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: 364369) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: 364369) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |