| NPI | 1639141773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C50652) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C50652) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2018-03-17 |