| NPI | 1033158605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL 101222) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL 101222) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-01-24 |