| NPI | 1770019069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: IA MD-47261) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: IA MD-47261) |
| 208D00000X General Practice (Licence: IA MD-47261) | |
| 208D00000X General Practice (Licence: CT 67614) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 68730) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2024-07-11 |