| NPI | 1952613697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A133506) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 2846971) |
| 282N00000X General Acute Care Hospital (Licence: CA A133506) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2024-04-09 |