| NPI | 1992820740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: PA 207055) |
| Additional Taxonomies | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: OH T1854925) |
| 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: NY 261258) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |