| NPI | 1861723108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP20024860) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME174884) |
| 207U00000X Nuclear Medicine (Licence: FL ME174884) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2026-05-15 |