| NPI | 1770554818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: WA RT00005601) |
| Additional Taxonomies | 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier (Licence: WA RT00005601) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2011-01-21 |