| NPI | 1790970754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: OH 35.153582) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301090992) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2025-07-30 |