| NPI | 1457399339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C-29367) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA C-29367) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C29367) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2024-01-12 |