| NPI | 1043359219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G72940) |
| Additional Taxonomies | 246RM2200X Technician, Pathology, Medical Laboratory (Licence: CA CLM322377) |
| 247100000X Radiologic Technologist (Licence: CA RHC138799) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2024-02-14 |