| NPI | 1902213861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: WA 60473309) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL 286250) |
| 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: FL 286250) | |
| 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: WA 60473309) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2016-06-25 |