| NPI | 1427210855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: CA A109975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 70471) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A109975) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2025-07-02 |