| NPI | 1043429152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A87385) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A87385) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-09-11 |