| NPI | 1316061674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A72830) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine, Nuclear Imaging & Therapy (Licence: CA A72830) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-02-25 |