| NPI | 1174567036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: PR 13021) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PR 13021) |
| 208D00000X General Practice (Licence: PR 13021) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-10-25 |