| NPI | 1174575583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K8800) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: LA MD.14005R) |
| 207U00000X Nuclear Medicine (Licence: TX K8800) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-03-01 |