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 |