| NPI | 1023988995 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: WA TR70027157) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA TR70027157) |
| 207U00000X Nuclear Medicine (Licence: WA TR70027157) | |
| Enumeration Date | 2025-11-06 |
| Last Update Date | 2025-11-06 |