| NPI | 1912054222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: FL ME30625) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: ND 9935) |
| 207U00000X Nuclear Medicine (Licence: WA MD00042982) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL ME30625) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: WA MD00042982) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: FL ME30625) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: ND 9935) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042982) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME30625) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 9935) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: ND 9935) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: WA MD00042982) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |