| NPI | 1366417818 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: PA MD427361)  | 
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD427361)  | 
| Enumeration Date | 2006-02-20 | 
| Last Update Date | 2012-05-21 |