| NPI | 1063544070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX H7120) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: TX H7120) |
| 207UN0901X Nuclear Medicine Nuclear Cardiology (Licence: TX H7120) | |
| 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: TX H7120) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX H7120) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-09 |