| NPI | 1447748736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: VA 0101283677) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101283677) |
| 208D00000X General Practice (Licence: VA 0101283677) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2024-08-23 |