| NPI | 1912984667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: PR 11861) |
| Additional Taxonomies | 2085N0904X (Licence: PR 11861) |
| 207R00000X Internal Medicine (Licence: PR 11861) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2011-11-15 |