| NPI | 1700094703 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: FL ME0041845)  | 
| Additional Taxonomies | 207UN0902X Nuclear Medicine, Nuclear Imaging & Therapy (Licence: FL ME 41845)  | 
| 207U00000X Nuclear Medicine (Licence: FL ME 41845)  | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL MR 41845)  | |
| Enumeration Date | 2007-05-21 | 
| Last Update Date | 2008-08-28 |