| NPI | 1952758963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: CA 529817) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: CA RHF00104640) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2016-05-19 |