| NPI | 1245227735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: KY TP163) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD036456E) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2018-03-17 |