| NPI | 1225325772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145718) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26445) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2021-12-03 |