| NPI | 1790292563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: TX W3243) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W3243) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2026-07-21 |