| NPI | 1467794164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A153914) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28085) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2024-04-05 |