| NPI | 1467452995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 203184) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C54580) |
| 208D00000X General Practice (Licence: NY 203184-1) | |
| 208D00000X General Practice (Licence: CA C54580) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2022-06-20 |