| NPI | 1568620821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD197196) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A102402) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A102402) | |
| 208D00000X General Practice (Licence: CA A102402) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2020-07-21 |