| NPI | 1811264807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: TX U1661) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: CA A122142) |
| 208D00000X General Practice (Licence: CA A122142) | |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2023-01-25 |