| NPI | 1821450024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A165736) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019025008) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2022-06-22 |