| NPI | 1770019069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: CA A201304) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 67614) |
| 208D00000X General Practice (Licence: IA MD-47261) | |
| 2085N0904X (Licence: IA MD-47261) | |
| 207U00000X Nuclear Medicine (Licence: IA MD-47261) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2025-09-18 |