| NPI | 1013238948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: IA MD-41864) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 166175) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2014-06-26 |