| NPI | 1972026896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246XS1301X Spec/Tech, Cardiovascular, Sonography (Licence: AZ 70271) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: AZ 70271) |
| 2471S1302X Radiologic Technologist, Sonography (Licence: AZ 70271) | |
| 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: AZ 70271) | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2022-07-21 |