| NPI | 1104073386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: UT 10237201-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 10237201-1205) |
| 207R00000X Internal Medicine (Licence: IL 125.054103) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2024-01-09 |