| NPI | 1104193606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist |
| Additional Taxonomies | 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |