| NPI | 1629000880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: CA C28976) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: CA C28976) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: CA C28976) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |