| NPI | 1396344859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471C3402X Radiologic Technologist, Radiography (Licence: VA 510394) |
| Additional Taxonomies | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: VA 510394) |
| 2471M1202X Radiologic Technologist, Magnetic Resonance Imaging (Licence: VA 510394) | |
| 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier (Licence: VA 510394) | |
| Enumeration Date | 2020-10-25 |
| Last Update Date | 2020-10-25 |