| NPI | 1043487911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M5885) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX M5885) |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2011-11-29 |