| NPI | 1043354293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471V0105X Radiologic Technologist Vascular Sonography (Licence: NY 239674) |
| Additional Taxonomies | 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2013-07-25 |