| NPI | 1730139239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G66190) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G66190) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2010-06-07 |