| NPI | 1750406286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A96563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A96563) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2021-12-01 |