| NPI | 1912192204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471V0105X Radiologic Technologist Vascular Sonography (Licence: TX 95167 ARDMS) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic (Licence: TX CERTIFICATE 627AAET) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2011-05-11 |