| NPI | 1992398531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: NJ 641056) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: NY 363102) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2021-02-15 |