| NPI | 1922019355 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: 330869) | 
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: 330869) | 
| 2471C3402X Radiologic Technologist, Radiography (Licence: 330869) | |
| Enumeration Date | 2006-08-10 | 
| Last Update Date | 2025-09-11 |