| NPI | 1609841667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: PR 11046) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PR 11046) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2012-10-01 |