| NPI | 1578658399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: TX M8317) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: TX M8317) |
| 207U00000X Nuclear Medicine (Licence: MA 1019016) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-10-15 |