| NPI | 1902042104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 243U00000X Radiology Practitioner Assistant (Licence: UT 09 UT 1-14) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: UT 119162-5401) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2008-12-18 |