| NPI | 1619980752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: MA 238034) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MA 238034) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2021-08-20 |