| NPI | 1134171986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier (Licence: CA FAC00029014) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: CA RHT 45586) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-04-07 |