| NPI | 1629077433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SD 1671) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: IA 23157) |
| 207U00000X Nuclear Medicine (Licence: MN 40507) | |
| 207U00000X Nuclear Medicine (Licence: NE 23078) | |
| 207U00000X Nuclear Medicine (Licence: SD 1671) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA 23157) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 40507) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 23078) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2013-02-25 |