| NPI | 1013099001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 017602) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 017602) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2017-04-25 |