| NPI | 1124023759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A49923) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine, Nuclear Imaging & Therapy (Licence: CA A49923) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2025-09-11 |