| NPI | 1891976189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A38899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A38899) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA a38899) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA a38899) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA a38899) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2013-02-08 |