| NPI | 1326039280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX E9595) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX E9595) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2015-09-09 |