| NPI | 1578578266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A86432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A86432) |
| 208000000X Pediatrics (Licence: CA A86432) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2019-02-19 |