| NPI | 1619137825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A140115) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101244091) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2021-08-12 |