| NPI | 1558366047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology (Licence: CA G64297) |
| Additional Taxonomies | 2471B0102X Radiologic Technologist, Bone Densitometry (Licence: CA RHC142268) |
| 261QR0200X Clinic/Center, Radiology (Licence: CA FAC52131) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2009-02-05 |