| NPI | 1730672221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: VA 0101285659) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 85064) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2025-06-11 |