| NPI | 1952315319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C42348) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA c42348) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-10-22 |