| NPI | 1043338163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G58639) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G58639) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2012-12-19 |