| NPI | 1134427172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0208X Clinic/Center, Radiology, Mobile (Licence: MN MNXO-1218) |
| Additional Taxonomies | 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2011-03-09 |