| NPI | 1205961364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: VA 0101056334) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101056334) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |