| NPI | 1023217726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: VA 0101041611) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MD D0035949) |
| 207U00000X Nuclear Medicine (Licence: DC BN1451397) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2007-11-01 |