| NPI | 1205877289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 130872-1) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA RHL116491) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-03-07 |