| NPI | 1730179763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: PA MD044843L) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA11186200) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35072816) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2023-11-21 |