| NPI | 1104045541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA a37275) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA a37275) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-04-13 |