| NPI | 1417418856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: CA A182515) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A182515) |
| 207R00000X Internal Medicine (Licence: IL 125.073727) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2026-03-05 |