| NPI | 1992299978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A20581) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018769) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-09-10 |