| NPI | 1932364577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A110763) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A110763) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2025-01-31 |