| NPI | 1649589243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A114008) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114008) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2022-06-13 |