| NPI | 1104819945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A42303) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: CA A42303) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2014-09-24 |