| NPI | 1528165008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C37370) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA C37370) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA C37370) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2018-05-15 |